Predicting therapy working alliance through client adult attachment and client perceptions of ...

348 Pages·2016·1.35 MB·English

by  Scott Eugene Bair

Iowa State University Capstones, Theses and
Retrospective Theses and Dissertations
Dissertations
2007
Predicting therapy working alliance through client
adult attachment and client perceptions of therapist
behaviors
Scott Eugene Bair
Iowa State University
Follow this and additional works at:https://lib.dr.iastate.edu/rtd
Part of theClinical Psychology Commons, and theMental and Social Health Commons
Recommended Citation
Bair, Scott Eugene, "Predicting therapy working alliance through client adult attachment and client perceptions of therapist behaviors"
(2007).Retrospective Theses and Dissertations. 15844.
https://lib.dr.iastate.edu/rtd/15844
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Predicting therapy working alliance through client adult attachment and client perceptions of
therapist behaviors

by

Scott Eugene Bair

A dissertation submitted to the graduate faculty
in partial fulfillment of the requirements for the degree of
DOCTOR OF PHILOSOPHY

Major: Human Development and Family Studies (Marriage and Family Therapy)

Program of Study Committee:
Ronald Werner-Wilson, Co-Major Professor
Dianne Draper, Co-Major Professor
Sedahlia Crase
Megan Murphy
Daniel Russell

Iowa State University
Ames, Iowa
2007
Copyright © Scott Eugene Bair, 2007. All rights reserved.
UMI Number: 3289443
Copyright 2007 by
Bair, Scott Eugene
All rights reserved.
UMI Microform3289443
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ii
TABLE OF CONTENTS
TABLE OF CONTENTS..........................................................................................................ii
LIST OF FIGURES................................................................................................................xii
LIST OF TABLES.................................................................................................................xvi
ACKNOWLEDGMENTS....................................................................................................xxii
I. INTRODUCTION.................................................................................................................1
II. LITERATURE REVIEW.....................................................................................................2
Attachment.............................................................................................................................2
Attachment Theory.............................................................................................................2
Attachment Behavioral System.....................................................................................4
Other Behavioral Systems.............................................................................................5
Internal Working Model................................................................................................8
Patterns of Attachment Responses................................................................................9
Adult Attachment Research..............................................................................................10
The Nuclear Family Tradition....................................................................................12
The Peer/Romantic Partner Tradition........................................................................14
Convergence in the Two Traditions............................................................................16
Current Directions in Adult Attachment Research.....................................................21
Attachment and Therapy..................................................................................................22
Working Alliance................................................................................................................23
Historical Background.....................................................................................................23
Bordin’s Pantheoretical Model of Working Alliance.......................................................24
Working Alliance Research..............................................................................................24
iii
Working Alliance and Attachment....................................................................................25
Conceptual Similarities of Working Alliance and Attachment...................................25
Research Involving Adult Attachment and Working Alliance.....................................26
Additional Variables of Interest.......................................................................................26
Demographic Variables..............................................................................................26
Depth and Smoothness of the Session.........................................................................26
Client Perceptions of Therapist Behaviors.................................................................28
Purpose of Study..................................................................................................................29
Statement of Research Questions........................................................................................30
III. METHODS.......................................................................................................................32
Participants..........................................................................................................................32
Sample description...........................................................................................................32
Procedure.............................................................................................................................33
Recruitment of Research Sites..........................................................................................33
The Research Packets.......................................................................................................36
Distribution of the Packets..........................................................................................36
Contents of the Research Packets...............................................................................36
Collection of Data................................................................................................................39
Time Frame......................................................................................................................39
Procedure at Therapy Sites..............................................................................................39
Research Plan.............................................................................................................39
Consent Process..........................................................................................................40
Procedure for Data Receipt and Recording.....................................................................41
iv
Questionnaire Return Rates.................................................................................................43
Missing Data and Participant Fatigue............................................................................43
Measures..............................................................................................................................50
Demographics and Therapy Information Items...............................................................50
Attachment Style Questionnaire (ASQ)............................................................................50
Session Evaluation Questionnaire (SEQ)........................................................................52
Working Alliance Inventory—Short Form (WAI-S).........................................................52
Therapist Behavior Items (TBI).......................................................................................53
Theoretical Grounding: Therapist Intentions.............................................................53
Early Measure Development.......................................................................................54
Construct Validity.......................................................................................................55
Face Validity...............................................................................................................56
Content Validity..........................................................................................................64
Focus: Supporting and Challenging Behaviors..........................................................64
IV. PRELIMINARY DATA ANALYSIS..............................................................................65
Standards for Addressing Problems with Data....................................................................65
Missing Data....................................................................................................................65
Response Anomalies.........................................................................................................67
Outlier Values..................................................................................................................68
Skewness and Kurtosis.....................................................................................................69
Normality of Data................................................................................................................70
Demographic Items..........................................................................................................70
Respondent Sex...........................................................................................................71
v
Race.............................................................................................................................71
Relationship Status......................................................................................................72
Sex of Therapist...........................................................................................................72
City Size......................................................................................................................74
Respondent Age...........................................................................................................76
Income.........................................................................................................................77
Sessions of Therapy.....................................................................................................81
Attachment Style Questionnaire.......................................................................................87
Session Evaluation Questionnaire...................................................................................93
Working Alliance Inventory—Short Form.......................................................................98
Reliability of Established Measures..................................................................................109
Reliability of Attachment Style Questionnaire...............................................................109
ASQ Confidence Subscale.........................................................................................109
ASQ Discomfort with Closeness Subscale................................................................111
ASQ Need for Approval Subscale.............................................................................112
ASQ Preoccupation with Relationships Subscale.....................................................113
ASQ Relationships as Secondary Subscale...............................................................113
Reliability of Session Evaluation Questionnaire............................................................115
SEQ Smoothness Subscale........................................................................................115
SEQ Depth Subscale.................................................................................................116
Reliability of Working Alliance Inventory—Short Form................................................116
WAI-S Task Dimension.............................................................................................116
WAI-S Bond Dimension............................................................................................117
vi
WAI-S Goal Dimension.............................................................................................118
WAI-S Scale (Overall)...............................................................................................121
Exploratory Principal Components Analysis of Therapist Behavior Items......................122
Limiting Item Numbers According to Rules of Thumb...................................................122
Conceptual Analysis I: Initial Solution..........................................................................124
Restructure................................................................................................................124
Support......................................................................................................................125
Data Screening I: Initial Solution..................................................................................127
Restructure Items Screening.....................................................................................127
Support Items Screening...........................................................................................129
Principal Components Analysis, Round 1, Part A: Restructure....................................134
Round 1.1A................................................................................................................134
Round 1.2A................................................................................................................139
Round 1.3A................................................................................................................143
Round 1.4A................................................................................................................146
Round 1.5A................................................................................................................147
Principal Components Analysis, Round 1, Part B: Support..........................................149
Round 1.1B................................................................................................................149
Round 1.2B................................................................................................................152
Round 1.3B................................................................................................................155
Principal Components Analysis, Round 2: Restructure and Support Combined...........158
Round 2.1..................................................................................................................158
Round 2.2..................................................................................................................162
vii
Conceptual Analysis II: Initial Solution.........................................................................165
Statistical Analysis I: Initial Solution.............................................................................166
Descriptives...............................................................................................................166
Reliability..................................................................................................................167
Data Screening II: Final Component Solution..............................................................169
Principal Components Analysis, Round 3......................................................................172
Round 3.1..................................................................................................................172
Round 3.2..................................................................................................................176
Round 3.3.......................................................................................................................180
Conceptual Analysis III: Final Component Solution.....................................................183
Statistical Analysis II: Final Component Solution.........................................................184
Scale Calculation for the TBI Scales, Final Component Solution............................184
Descriptives for the TBI Scales, Final Component Solution....................................185
Reliability of the TBI Scales, Final Component Solution.........................................191
Improved Reliability with First Sessions Dropped...................................................194
V. RESULTS........................................................................................................................196
Demographics....................................................................................................................196
Demographics and Primary Measures..........................................................................197
Attachment Style Questionnaire................................................................................200
Session Evaluation Questionnaire............................................................................200
Working Alliance Inventory—Short Form................................................................201
Therapist Behavior Items..........................................................................................202
Correlations between the Primary Measures.................................................................203
viii
Hierarchical Regression.....................................................................................................204
Predictive Value of Demographic Variables for Working Alliance...............................206
Predictive Value of Adult Attachment for Working Alliance.........................................208
Predictive Value of Quality of Session for Working Alliance........................................217
Predictive Value of Therapist Behaviors for Working Alliance.....................................218
VI. DISCUSSION.................................................................................................................221
Therapist Behaviors...........................................................................................................221
Support: Difficulties with Operationalization................................................................222
Challenging/Confronting...............................................................................................223
The Unexpected Third Component...........................................................................223
Confrontation in Other Literature............................................................................225
Demographics....................................................................................................................227
ASQ and Demographics.................................................................................................228
Sex and Confidence...................................................................................................228
Committed Relationship and Confidence and Discomfort with Closeness...............229
Sex of Therapist and Confidence and Discomfort with Closeness...........................229
Sessions of Therapy and Confidence and Discomfort with Closeness.....................230
Therapy Modality and ASQ......................................................................................230
Some Couple and Some Family Therapy and ASQ...................................................231
Couple and Family Therapy Only and Need for Approval.......................................231
Demographics and SEQ.................................................................................................232
Demographics and WAI-S..............................................................................................235
Income (-)..................................................................................................................235